DOCSLIB.ORG

Dysfunctional Uterine Bleeding

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Dysfunctional Uterine Bleeding NWT Clinical Practice Guidelines for Primary Community Care Nursing - Women’s Health and Gynecology Dysfunctional Uterine Bleeding (DUB) Definition Menorrhagia may signify a bleeding disorder or a Abnormal uterine bleeding not caused by pelvic structural lesion, such as uterine leiomyomas, pathology, medications, systemic disease or adenomyosis or endometrial polyps. pregnancy. It is the most common cause (in 90% Up to 20% of adolescents who present with of cases) of abnormal uterine bleeding but is a menorrhagia have a bleeding disorder such as von diagnosis of exclusion. Willebrand's disease. Liver disease with resultant coagulation abnormalities and chronic renal failure Causes may also cause menorrhagia. Usually related to one of three hormonal- imbalance conditions: estrogen breakthrough Polymenorrhea is usually caused by an inadequate bleeding, estrogen withdrawal bleeding and luteal phase or a short follicular phase. progesterone breakthrough bleeding. Oligomenorrhea in an ovulating woman is usually Anovulatory Dysfunctional Uterine caused by a prolonged follicular phase. Bleeding Anovulation is the most common cause of DUB in Intermenstrual bleeding may be caused by cervical reproductive-age women. It is especially common disease or the presence of an intrauterine in adolescents. Up to 80% of menstrual cycles are contraceptive device. anovulatory in the first year after menarche. Cycles become ovulatory an average of 18-20 Midcycle spotting may result from the rapid months after menarche. decline in estrogen levels before ovulation. Some women still have anovulatory cycles after For other causes of abnormal uterine bleeding, see the hypothalamic-pituitary axis matures. Weight Table 2, above, this chapter. loss, eating disorders, stress, chronic illness or excessive exercise may all cause hypothalamic History anovulation. • Age (e.g. reproductive age or menopausal) • Amount, duration, frequency, interval of Another cause of anovulation is polycystic ovarian bleeding disease. This unopposed estrogen state increases • Try to determine if cycles are ovulatory or the risk of endometrial hyperplasia and cancer. anovulatory (see Table 3, this chapter) • Date of last normal menstrual period Some women with chronic anovulation do not fall • Any contraception use (type, how used) into any of the above categories and are • Hormone replacement therapy if considered to have idiopathic chronic anovulation. postmenopausal • Possibility of pregnancy All causes of anovulation represent a • Signs of easy bleeding (e.g. gums) or bruising progesterone-deficient state. suggestive of coagulopathy • Any pain associated with bleeding Ovulatory Dysfunctional Uterine • Past history of gynecological problems such as Bleeding abnormal Papanicolaou (Pap) smear, fibroids, Although less common than anovulatory bleeding, sexually transmitted diseases (STIs), ovulatory DUB may also occur. DUB in women gynecological malignancy, prior episodes of with ovulatory cycles occurs as regular, cyclic abnormal uterine bleeding bleeding. • Past history of thyroid, renal or hepaticdisease • History of strenuous physical exercise (which may cause DUB) September 2004 Dysfunctional Uterine Bleeding (DUB) - Adult 1 NWT Clinical Practice Guidelines for Primary Community Care Nursing - Women’s Health and Gynecology • Eating disorder, significant emotional or A full gynecological examination, including psychological stress determination of blood pressure and weight and • Date and result of most recent Pap smear examination of thyroid, breasts, abdomen and • Date and result of most recent mammography pelvic area (bimanual), should be performed. Physical Findings The pelvic examination consists of careful DUB is a symptom, not a diagnosis. The findings inspection of the lower genital tract for lacerations, are variable, depending upon underlying cause. vulvar or vaginal pathology, and cervical lesions The results of the examination may be deceptively or polyps. Bimanual uterine examination may normal or obviously abnormal. reveal enlargement from uterine fibroids, adenomyosis or endometrial carcinoma. Table 3: Characteristics of Ovulatory and Anovulatory Menstrual Cycles Feature Ovulatory cycle Anovulatory cycle Cycle length Regular Unpredictable Premenstrual symptoms Present None Bleeding Dysmenorrhea Unpredictable bleeding pattern; frequent spotting; infrequent, heavy bleeding Breasts Tender Non-tender Basal temperature curve Biphasic Monophasic Other Change in cervical mucus Mittelschmerz Differential Diagnosis whom there is no response to initial management See Table 2, in "Abnormal Uterine Bleeding," strategies. above, this chapter. These tests would be ordered by a physician. Diagnostic Tests • Urine pregnancy testing for all patients of Endometrial biopsy and ultrasonography should be reproductive age performed early in the investigation of bleeding in any postmenopausal woman. • Complete blood count (to provide a measure of blood loss and adequacy of platelet count) • Prothrombin time (PT) and partial Management thromboplastin time (PTT) Goals of Treatment • Levels of thyroid-stimulating hormone (TSH) • Rule out organic pathology and prolactin • Regulate menstrual cycles • Liver function tests (ALT and total bilirubin) • Prevent complications • Cervical and vaginal samples for culture • Pap smear Specific management depends on the underlying cause. • Pelvic ultrasonography if organic pathology is suspected Premenopausal Women If the reproductive-age woman is not pregnant, the Refer for endometrial biopsy early in the results of the physical examination are normal, and investigation of any woman who is > 35 years of all pathologic, structural and iatrogenic causes age, postmenopause, or who has a history of have been excluded, abnormal uterine bleeding is prolonged exposure to unopposed estrogen in September 2004 Dysfunctional Uterine Bleeding (DUB) - Adult 2 NWT Clinical Practice Guidelines for Primary Community Care Nursing - Women’s Health and Gynecology usually dysfunctional in nature and can be endometrial carcinoma. Of all postmenopausal managed with hormonal therapy. See Table 4, women with bleeding, 5% to 10% are found to below, this chapter. have endometrial carcinoma. Other potential causes of bleeding are cervical cancer, cervicitis, Postmenopausal Women atrophic vaginitis, endometrial atrophy, The most serious concern in postmenopausal submucous fibroids, endometrial hyperplasia and women with abnormal uterine bleeding is endometrial polyps. Table 4: Pharmacologic treatment for dysfunctional uterine bleeding Age group Treatment* Comments Premenopausal OCP Low-dose (35 mcg) monophasic or triphasic OCP can regulate cycles while providing contraception medroxyprogesterone 10 mg PO od for If contraception is not an issue, medroxyprogesterone can 10 days be used to regulate cycles; in a woman who has or amenorrhea or oligomenorrhea, medroxyprogesterone medroxyprogesterone 150 mg IM every 3 months can protect against endometrial q3months hyperplasia Perimenopausal medroxyprogesterone 10 mg PO od for May be used monthly to regulate bleeding pattern 10 days Usually use 20 mcg pills; OCP can be continued until the OCP woman has finished menopause, then change to HRT (OCP may be relatively contraindicated in women > 35 years of age who smoke) Postmenopausal Cyclic HRT May consider increasing the progesterone dose if early (receiving withdrawal bleeding occurs; increase estrogen dose if HRT) intermenstrual bleeding is present Continuous combined HRT (B class May increase the estrogen dose for 1-3 months to drug) stabilize endometrium; may also try increasing the progesterone dose; if bleeding continues, consider With continuous combined HRT, up to changing regimen to cyclic HRT or using a different type 40% of women have irregular bleeding of estrogen in the first 4-6 months of therapy (Rubin et al. 1996). Bleeding is more common when hormone therapy is started less than 12 months after menopause occurs. * hormonal drugs used as treatment for DUB and not as contraceptives are all B class drugs Women Receiving Hormone interactions or malabsorption. If unscheduled Replacement Therapy bleeding occurs in two or more cycles, further Women receiving hormone replacement therapy evaluation is indicated. often present with abnormal bleeding and of these, 30% have uterine pathology. Other causes include Appropriate Consultation cervical lesions, vaginal pathology or the hormone Consult a physician before ordering diagnostic therapy itself. tests and for medication treatment options if urgent treatment is warranted. Women receiving sequential hormone replacement therapy may experience midcycle breakthrough bleeding because of missed pills, medication September 2004 Dysfunctional Uterine Bleeding (DUB) - Adult 3 NWT Clinical Practice Guidelines for Primary Community Care Nursing - Women’s Health and Gynecology Monitoring and Follow-Up Referral • Follow up monthly until cycles have become • Refer electively any client (if she is stable) to a regular physician for thorough evaluation and treatment. • Monitor hemoglobin as needed if heavy bleeding continues despite therapy September 2004 Dysfunctional Uterine Bleeding (DUB) - Adult 4.
Load more

Recommended publications
  • Prolactin Level in Women with Abnormal Uterine Bleeding Visiting Department of Obstetrics and Gynecology in a University Teaching Hospital in Ajman, UAE
    Prolactin level in women with Abnormal Uterine Bleeding visiting Department of Obstetrics and Gynecology in a University teaching hospital in Ajman, UAE Jayakumary Muttappallymyalil1*, Jayadevan Sreedharan2, Mawahib Abd Salman Al Biate3, Kasturi Mummigatti3, Nisha Shantakumari4 1Department of Community Medicine, 2Statistical Support Facility, CABRI, 4Department of Physiology, Gulf Medical University, Ajman, UAE 3Department of OBG, GMC Hospital, Ajman, UAE *Presenting Author ABSTRACT Objective: This study was conducted among women in the reproductive age group with abnormal uterine bleeding (AUB) to determine the pattern of prolactin level. Materials and Methods: In this study, a total of 400 women in the reproductive age group with AUB attending GMC Hospital were recruited and their prolactin levels were evaluated. Age, marital status, reproductive health history and details of AUB were noted. SPSS version 21 was used for data analysis. Descriptive statistics was performed to describe the population, and inferential statistics such as Chi-square test was performed to find the association between dependent and independent variables. Results: Out of 400 women, 351 (87.8%) were married, 103 (25.8%) were in the age group 25 years or below, 213 (53.3%) were between 26-35 years and 84 (21.0%) were above 35 years. Mean age was 30.3 years with a standard deviation 6.7. The prolactin level ranged between 15.34 mIU/l and 2800 mIU/l. The mean and SD observed were 310 mIU/l and 290 mIU/l respectively. The prolactin level was high among AUB patients with inter-menstrual bleeding compared to other groups. Additionally, the level was high among women with age greater than 25 years compared to those with age less than or equal to 25 years.
    [Show full text]
  • Endometriosis for Dummies.Pdf
    01_050470 ffirs.qxp 9/26/06 7:36 AM Page i Endometriosis FOR DUMmIES‰ by Joseph W. Krotec, MD Former Director of Endoscopic Surgery at Cooper Institute for Reproductive Hormonal Disorders and Sharon Perkins, RN Coauthor of Osteoporosis For Dummies 01_050470 ffirs.qxp 9/26/06 7:36 AM Page ii Endometriosis For Dummies® Published by Wiley Publishing, Inc. 111 River St. Hoboken, NJ 07030-5774 www.wiley.com Copyright © 2007 by Wiley Publishing, Inc., Indianapolis, Indiana Published by Wiley Publishing, Inc., Indianapolis, Indiana Published simultaneously in Canada No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permit- ted under Sections 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600. Requests to the Publisher for permission should be addressed to the Legal Department, Wiley Publishing, Inc., 10475 Crosspoint Blvd., Indianapolis, IN 46256, 317-572-3447, fax 317-572-4355, or online at http:// www.wiley.com/go/permissions. Trademarks: Wiley, the Wiley Publishing logo, For Dummies, the Dummies Man logo, A Reference for the Rest of Us!, The Dummies Way, Dummies Daily, The Fun and Easy Way, Dummies.com, and related trade dress are trademarks or registered trademarks of John Wiley & Sons, Inc., and/or its affiliates in the United States and other countries, and may not be used without written permission.
    [Show full text]
  • The Prevalence of and Attitudes Toward Oligomenorrhea and Amenorrhea in Division I Female Athletes
    POPULATION-SPECIFIC CONCERNS The Prevalence of and Attitudes Toward Oligomenorrhea and Amenorrhea in Division I Female Athletes Karen Myrick, DNP, APRN, FNP-BC, Richard Feinn, PhD, and Meaghan Harkins, MS, BSN, RN • Quinnipiac University Research has demonstrated that amenor- hormone and follicle-stimulating hormone rhea and oligomenorrhea may be common shut down stimulation to the ovary, ceasing occurrences among female athletes.1 Due production of estradiol.2 to normalization of menstrual dysfunction The effect of oral contraceptives on the within the sport environment, amenorrhea menstrual cycle include ovulation inhibi- and oligomenorrhea tion, changes in cervical mucus, thinning may be underreported. of the uterine endometrium, and motility Key PointsPoints There are many underly- and secretion in the fallopian tubes, which Lean sport athletes are more likely to per- ing causes of menstrual decrease the likelihood of conception and 3 ceive missed menstrual cycles as normal. dysfunction. However, implantation. Oral contraceptives contain a a similar hypothalamic combination of estrogen and progesterone, Menstrual dysfunction is one prong of the amenorrhea profile is or progesterone only; thus, oral contracep- female athlete triad. frequently seen in ath- tives do not stop the production of estrogen. letes, and hypothalamic Menstrual dysfunction is one prong of the Menstrual dysfunction is often associated dysfunction is com- female athlete triad (triad). The triad is a with musculoskeletal and endothelial monly the root of ath- syndrome of linking low energy availability compromise. lete’s menstrual abnor- (EA) with or without disordered eating, men- malities.2 The common strual disturbances, and low bone mineral Education and awareness of the accultur- hormone pattern for density, across a continuum.
    [Show full text]
  • Prevalence of Menstrual Irregularities in Correlation with Body Fat Among Students of Selected Colleges in a District of Tamil Nadu, India
    National Journal of Physiology, Pharmacy and Pharmacology RESEARCH ARTICLE Prevalence of menstrual irregularities in correlation with body fat among students of selected colleges in a district of Tamil Nadu, India Sherly Deborah G1, Siva Priya D V2, Rama Swamy C2 1Department of Physiology, Faculty of Medicine, AIMST University, Bedong, Kedah, Malaysia, 2Department of Physiology, Saveetha Medical College, Chennai, Tamil Nadu, India Correspondence to: Sherly Deborah G, E-mail: [email protected] Received: March 05, 2017; Accepted: March 22, 2017 ABSTRACT Background: Menstrual irregularities are usually due to imbalance of hormones. Although menstrual irregularities may be normal during the early postmenarchal years, pathological conditions require proper and prompt management. Obesity associated with many health consequences including hormonal imbalance has a direct effect on menstrual cycle. Hence, attention to obesity is obligatory for the inclusion of diagnosis and treatment of menstrual complaints which has become a leading issue in women’s life. Aims and Objectives: The aims and objectives of the study are to assess the menstrual irregularities and to find the association between menstrual irregularities and body fat among students. Materials and Methods: A cross-sectional study was conducted in three selected colleges in a district of Tamil Nadu in India. A total of 399 samples were included in the study. A 10-item questionnaire was administered to assess the menstrual irregularity in each student. The demographic variables along with anthropometric measurements were collected. Anthropometric measurements were taken to calculate the body fat percentage using modified YMCA formula. Results: The prevalence of menstrual irregularities was high in obesity compared with those with normal body fat and particularly oligomenorrhea, amenorrhea, and hypomenorrhea had statistically significant increase in obese students.
    [Show full text]
  • Infertility Update
    Infertility Update George R Attia, M.D Director of IVF Program University of Texas Southwestern Medical Center at Dallas Infertility • Inability to conceive after one year of adequate unprotected intercourse (six months if the woman is over age 35) Time Required for Conception in Couples Who Will Attain Pregnancy 100 93 95 90 85 80 72 70 nt 57 60 na g 45 e 50 r P 40 % 30 25 20 10 0 1 month 2 months 3 months 6 months 1 Year 2 Year 3 ear 7% 3% 35% Male Factor 20% Tubal Factor Ov dysfunction Unexplained Others 35% 10% 10% 40% Anovulatory Tubal & Pelvic Unusual factors Unexplained 40% • Anovulation • Tubal Factor • Male • Pelvic Factor (Endometriosis, adhesion) • Unexplained • Uterine/cervical (fibroid) 10% PCOS Others 90% Ovulation • History •BBT • LH kits • Mid luteal phase Progesterone (cycle length –7) • Ultrasound • EMB (day 21-26) • Anovulation • Tubal / Pelvic Factor • Male • Unexplained • Uterine/cervical (fibroid) Tubal & Pelvic Factors • Tubal disease, PID • Tubal surgery • Pelvic adhesions • Endometriosis Tubal Factor • Tubal infertility after PID (12%, 24%, 50%) • One-half of patients who found to have tubal damage and/or pelvic adhesion have no history of antecedent disease Tubal Factor • Hysterosalpingography • Hysteroscopy / laparoscopy • Falloscopy • Anovulation • Tubal Factor • Male • Unexplained • Uterine/cervical (fibroid) Male Factor Infertility • Anatomic defects (hypospadias, Retrograde ejac.) • Genetics Causes • Trauma • Infection • Endocrine disorders •Varicocele Male Factor Infertility • Vol. > 2 ml, Conc. > 20x106,
    [Show full text]
  • Polycystic Ovary Syndrome, Oligomenorrhea, and Risk of Ovarian Cancer Histotypes: Evidence from the Ovarian Cancer Association Consortium
    Published OnlineFirst November 15, 2017; DOI: 10.1158/1055-9965.EPI-17-0655 Research Article Cancer Epidemiology, Biomarkers Polycystic Ovary Syndrome, Oligomenorrhea, and & Prevention Risk of Ovarian Cancer Histotypes: Evidence from the Ovarian Cancer Association Consortium Holly R. Harris1, Ana Babic2, Penelope M. Webb3,4, Christina M. Nagle3, Susan J. Jordan3,5, on behalf of the Australian Ovarian Cancer Study Group4; Harvey A. Risch6, Mary Anne Rossing1,7, Jennifer A. Doherty8, Marc T.Goodman9,10, Francesmary Modugno11, Roberta B. Ness12, Kirsten B. Moysich13, Susanne K. Kjær14,15, Estrid Høgdall14,16, Allan Jensen14, Joellen M. Schildkraut17, Andrew Berchuck18, Daniel W. Cramer19,20, Elisa V. Bandera21, Nicolas Wentzensen22, Joanne Kotsopoulos23, Steven A. Narod23, † Catherine M. Phelan24, , John R. McLaughlin25, Hoda Anton-Culver26, Argyrios Ziogas26, Celeste L. Pearce27,28, Anna H. Wu28, and Kathryn L. Terry19,20, on behalf of the Ovarian Cancer Association Consortium Abstract Background: Polycystic ovary syndrome (PCOS), and one of its cancer was also observed among women who reported irregular distinguishing characteristics, oligomenorrhea, have both been menstrual cycles compared with women with regular cycles (OR ¼ associated with ovarian cancer risk in some but not all studies. 0.83; 95% CI ¼ 0.76–0.89). No significant association was However, these associations have been rarely examined by observed between self-reported PCOS and invasive ovarian cancer ovarian cancer histotypes, which may explain the lack of clear risk (OR ¼ 0.87; 95% CI ¼ 0.65–1.15). There was a decreased risk associations reported in previous studies. of all individual invasive histotypes for women with menstrual Methods: We analyzed data from 14 case–control studies cycle length >35 days, but no association with serous borderline including 16,594 women with invasive ovarian cancer (n ¼ tumors (Pheterogeneity ¼ 0.006).
    [Show full text]
  • Consensus Statement
    CONSENSUS STATEMENT ISUOG Consensus Statement on rationalization of gynecological ultrasound services in context of SARS-CoV-2 INTRODUCTION Given the challenges of the current coronavirus (SARS-CoV-2) pandemic and to protect both patients and ultrasound providers (physicians, sonographers, allied professionals), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) has compiled the following expert-opinion-based guidance for the rationalization of ultrasound investigations for gynecological indications. While the provision of ultrasound is an essential service and all individuals with gynecological complaints deserve high-quality investigation, the current coronavirus disease 2019 (COVID-19) pandemic warrants triaging of referrals for gynecological ultrasound assessment. This is based on the following principles related to a pandemic: 1. Medical resources should be spared and prioritized. 2. Maximum care should be taken to avoid unnecessary contact between (potentially infected) medical personnel and (potentially infected) patients. The risk of transmission is particularly high during ultrasound investigations as neither the medical personnel nor the patient can abide by the social distancing recommendations. 3. Visits should be limited to those strictly necessary to avoid spread of the virus. Therefore, ultrasound appointments for gynecological indications should be triaged based on the clinical scenario, as follows: 1. Ultrasound assessments that should be performed without delay (NOW); 2. Ultrasound assessments
    [Show full text]
  • Jceme114.Pdf
    JCEM ONLINE Brief Report—Endocrine Research Menstrual Irregularity and Cardiovascular Mortality Erica T. Wang, Piera M. Cirillo, Eric Vittinghoff, Kirsten Bibbins-Domingo, Barbara A. Cohn, and Marcelle I. Cedars Center for Research on Women’s and Children’s Health, Public Health Institute, University of California San Francisco, San Francisco, California 94115 Downloaded from https://academic.oup.com/jcem/article/96/1/E114/2833816 by guest on 29 September 2021 Background: Polycystic ovary syndrome, the most common cause of irregular menstrual cycles, is associated with an adverse cardiovascular risk profile. However, there are limited prospective studies confirming the link between polycystic ovary syndrome and cardiovascular mortality. Methods: We studied 15,005 pregnant women recruited from the Kaiser Foundation Health Plan in California between 1959 and 1966. The menstrual cycle pattern was assessed at baseline ac- cording to self-report, physician report, and medical record abstraction. Participants were matched to California Vital Status files annually until 2007 to identify deaths due to overall cardiovascular disease (CVD) and subsets of coronary heart disease (CHD) and cerebrovascular disease based on International Classification of Diseases codes. Cox proportional hazards models were used to es- timate the association between irregular cycles and cardiovascular mortality. Missing covariate data were multiply imputated using standard methods. Results: During 456,298.5 person-years of follow-up, there were 666 CVD deaths, including 301 CHD deaths and 149 cerebrovascular deaths. Compared with women with regular cycles, women with irregular cycles had an increased risk for CHD mortality [age adjusted hazards ratio (HR) 1.42, 95% confidence interval (CI) 1.03–1.94]; however, the association was not statistically significant after adjustment for body mass index (adjusted HR 1.35, 95% CI 0.98–1.85).
    [Show full text]
  • American Family Physician Web Site At
    Diagnosis and Management of Adnexal Masses VANESSA GIVENS, MD; GREGG MITCHELL, MD; CAROLYN HARRAWAY-SMITH, MD; AVINASH REDDY, MD; and DAVID L. MANESS, DO, MSS, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee Adnexal masses represent a spectrum of conditions from gynecologic and nongynecologic sources. They may be benign or malignant. The initial detection and evaluation of an adnexal mass requires a high index of suspicion, a thorough history and physical examination, and careful attention to subtle historical clues. Timely, appropriate labo- ratory and radiographic studies are required. The most common symptoms reported by women with ovarian cancer are pelvic or abdominal pain; increased abdominal size; bloating; urinary urgency, frequency, or incontinence; early satiety; difficulty eating; and weight loss. These vague symptoms are present for months in up to 93 percent of patients with ovarian cancer. Any of these symptoms occurring daily for more than two weeks, or with failure to respond to appropriate therapy warrant further evaluation. Transvaginal ultrasonography remains the standard for evaluation of adnexal masses. Findings suggestive of malignancy in an adnexal mass include a solid component, thick septations (greater than 2 to 3 mm), bilaterality, Doppler flow to the solid component of the mass, and presence of ascites. Fam- ily physicians can manage many nonmalignant adnexal masses; however, prepubescent girls and postmenopausal women with an adnexal mass should be referred to a gynecologist or gynecologic oncologist for further treatment. All women, regardless of menopausal status, should be referred if they have evidence of metastatic disease, ascites, a complex mass, an adnexal mass greater than 10 cm, or any mass that persists longer than 12 weeks.
    [Show full text]
  • Intermenstrual Bleeding (Bleeding Between Periods)
    Intermenstrual Bleeding (Bleeding between periods) What is Intermenstrual bleeding? This is unscheduled bleeding that can occur in between periods. There are many different causes of bleeding between periods but seek medical advice if you are experiencing this, even if it is for reassurance in many situations. What is the nature of bleeding? Bleeding that occurs randomly without any relation to your monthly period should not be ignored, unless the cause is known. The bleeding may be light blood, spotting, a bloody or dark brown vaginal loss or heavy bleeding mimicking a period. Mid cycle pain and bleeding Mittelschmerz is one-sided, lower abdominal pain associated with ovulation, about 14 days before your next menstrual period. In most cases, mittelschmerz does not require medical attention and may be associated with light vaginal bleeding for a day or so. It may not occur every month. If you are concerned, seek advice. Spotting in the lead up to or at the end of the period Usually, this just suggests that levels of progesterone fall slightly more slowly in some cycles and can lead to spotting seen in the lead up to the proper menstrual flow. This is usually not a concern. Spotting or a brown vaginal loss as the period finishes is also not abnormal, unless lasting for days or associated with other symptoms. (See information on a normal menstrual cycle under the leaflet on Irregular Periods) What are the possible causes of bleeding between periods? (not an exhaustive list) Hormonal contraceptives, such as the combined or progesterone only pill, implant, injection, intrauterine system, patch, ring can all cause bleeding between cycles, especially in the first few months of starting them.
    [Show full text]
  • Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009†
    Human Reproduction, Vol.24, No.11 pp. 2683–2687, 2009 Advanced Access publication on October 4, 2009 doi:10.1093/humrep/dep343 SIMULTANEOUS PUBLICATION Infertility The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009† F. Zegers-Hochschild1,9, G.D. Adamson2, J. de Mouzon3, O. Ishihara4, R. Mansour5, K. Nygren6, E. Sullivan7, and S. van der Poel8 on behalf of ICMART and WHO 1Unit of Reproductive Medicine, Clinicas las Condes, Santiago, Chile 2Fertility Physicians of Northern California, Palo Alto and San Jose, California, USA 3INSERM U822, Hoˆpital de Biceˆtre, Le Kremlin Biceˆtre Cedex, Paris, France 4Saitama Medical University Hospital, Moroyama, Saitana 350-0495, JAPAN 53 Rd 161 Maadi, Cairo 11431, Egypt 6IVF Unit, Sophiahemmet Hospital, Stockholm, Sweden 7Perinatal and Reproductive Epidemiology and Research Unit, School Women’s and Children’s Health, University of New South Wales, Sydney, Australia 8Department of Reproductive Health and Research, and the Special Program of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland 9Correspondence address: Unit of Reproductive Medicine, Clinica las Condes, Lo Fontecilla, 441, Santiago, Chile. Fax: 56-2-6108167, E-mail: [email protected] background: Many definitions used in medically assisted reproduction (MAR) vary in different settings, making it difficult to standardize and compare procedures in different countries and regions. With the expansion of infertility interventions worldwide, including lower resource settings, the importance and value of a common nomenclature is critical. The objective is to develop an internationally accepted and continually updated set of definitions, which would be utilized to standardize and harmonize international data collection, and to assist in monitoring the availability, efficacy, and safety of assisted reproductive technology (ART) being practiced worldwide.
    [Show full text]
  • Diagnostic Evaluation of the Infertile Female: a Committee Opinion
    Diagnostic evaluation of the infertile female: a committee opinion Practice Committee of the American Society for Reproductive Medicine American Society for Reproductive Medicine, Birmingham, Alabama Diagnostic evaluation for infertility in women should be conducted in a systematic, expeditious, and cost-effective manner to identify all relevant factors with initial emphasis on the least invasive methods for detection of the most common causes of infertility. The purpose of this committee opinion is to provide a critical review of the current methods and procedures for the evaluation of the infertile female, and it replaces the document of the same name, last published in 2012 (Fertil Steril 2012;98:302–7). (Fertil SterilÒ 2015;103:e44–50. Ó2015 by American Society for Reproductive Medicine.) Key Words: Infertility, oocyte, ovarian reserve, unexplained, conception Use your smartphone to scan this QR code Earn online CME credit related to this document at www.asrm.org/elearn and connect to the discussion forum for Discuss: You can discuss this article with its authors and with other ASRM members at http:// this article now.* fertstertforum.com/asrmpraccom-diagnostic-evaluation-infertile-female/ * Download a free QR code scanner by searching for “QR scanner” in your smartphone’s app store or app marketplace. diagnostic evaluation for infer- of the male partner are described in a Pregnancy history (gravidity, parity, tility is indicated for women separate document (5). Women who pregnancy outcome, and associated A who fail to achieve a successful are planning to attempt pregnancy via complications) pregnancy after 12 months or more of insemination with sperm from a known Previous methods of contraception regular unprotected intercourse (1).
    [Show full text]